and other infections and diseases. TMA also backs efforts to improve access to preconception health care, including breast- feeding education, weight management, tobacco cessation, planning families, and avoiding unplanned pregnancy.
Tearing the safety net DSHS Press Officer Carrie Williams says the department used
family planning money to serve about 220,000 women at about 300 Texas clinics last year. Since the legislature cut the state budget for family planning services by $73 million, DSHS can now fund only 40,000 to 60,000 women at 143 clinics. She notes DSHS “took geographic fairness and access to
care into consideration when allocating the dollars, but still, the dollars available were reduced significantly, by two-thirds.” Ms. Williams says DSHS is in the early stages of preparing for how it will approach family planning messaging and fund- ing concerns next legislative session. “With the reductions last session, we are communicating the scope of our family planning program and the included services,” she said. Fortunately, state funds weren’t People’s Community Clinic’s
only source of paying for family planning and other services. Dr. Neavel explains that the clinic is a full-service primary care medical home that relies on community support and pri- vate donations for about 60 percent of its $7.2 million annual budget.
“The funds we received for family planning services didn’t just cover birth control. I use that money, for example, to give teens comprehensive wellness physicals that include some health education and some screenings, such as diabetes and cholesterol,” she said. Dr. Neavel says funds also benefit the clinic’s adult pa- tients, who receive breast and pelvic exams and recommended screenings.
“It’s about health, bottom line. It’s not just about birth con-
trol,” Dr. Neavel said. “We want to continue seeing patients who rely on us. We don’t want them to end up in the emer- gency room.” Janet Realini, MD, is concerned about cuts to family plan- ning funds and the transitions set to occur within the WHP. “In Texas, we’re shooting ourselves in both feet, and the situation has reached crisis level,” she said, adding that the state is “experiencing a 1-2 punch: The $73 million reduction in DSHS family planning funds and the possible exclusion of Planned Parenthood from the WHP threaten to tear the state’s safety net.” Dr. Realini is president of Healthy Futures of Texas, the non-
profit arm of Healthy Futures Alliance, a community coalition dedicated to reducing teen and unplanned pregnancies. José Camacho, executive director and general counsel for
the Texas Association of Community Health Centers, worries about the ability of Texas’ 69 federally qualified health centers (FQHCs) and 330 clinic sites to meet increased demand from Medicare, Medicaid, CHIP, insured, and uninsured patients. He’s concerned because fewer facilities will be able to serve patients due to the funding cuts in family planning. Those
Texans may seek health services at FQHCs that may not have the capacity to serve them. “Health professionals at FQHCs see patients for more than just family planning services. Many women have untreated diabetes or hypertension that needs to be addressed. We’re starting to see more demand for medical appointments, includ- ing family planning,” Mr. Camacho said.
Cuts could have consequences Kimberly Carter, MD, an Austin obstetrician-gynecologist and
member of the TMA Council on Science and Public Health, says funding family planning services for low-income women is essential to reducing the unplanned pregnancy rate in Texas. According to 2006 data (the latest available) from the National Campaign to Prevent Teen and Unplanned Pregnancy, 62 per- cent of pregnancies in Texas women aged 15 to 44 are un- planned, defined as “pregnancies that, at the time of concep- tion, are either mistimed (the mother wanted the pregnancy to occur at a later time) or unwanted (mother did not want it to occur at that time or any time in the future).” “The most effective way of preventing unplanned pregnan- cy is ensuring women have access to birth control,” said Dr. Carter. Texas’ rate of unplanned pregnancy is much higher than
the national average. “Unintended Pregnancy in the United States: Incidence and Disparities,” published in 2006 in the journal Contraception, says unintended pregnancy affected 49 percent of pregnancies among American women in 2006, up slightly from 48 percent in 2001. Of those unplanned preg- nancies, 43 percent ended in abortion nationwide. Research findings specify the unintended pregnancy rate was two to three times higher among women aged 18 to 24 who were poor or cohabiting. Researchers conclude that “efforts to help women and couples plan their pregnancies, such as increasing access to effective contraceptives, should focus on groups at greatest risk for unintended pregnancy, particularly poor and cohabiting women.” Dr. Realini concurs.
“Supporting and expanding access to preventive care and birth control is an effective way to help reduce abortion,” she said. “In my personal opinion, it’s misguided to cut funds to family planning services.” Yasser Zeid, MD, chair of the TMA Committee on Maternal
and Perinatal Health and a Longview obstetrician-gynecologist, echoes her opinion. “As far as I’m concerned, limiting access to birth control in- advertently increases the risk of abortion,” he said. Based on the reductions in family planning services, ap-
proximately 20,000 additional Texas women will give birth within the next year, says Dr. Carter, citing a May 2011 Leg- islative Budget Board memorandum (
www.lrl.state.tx.us/ scanned/archive/2011/15623.pdf) about reduced funding for family planning services. According to the document, these births will cost Medicaid $231 million in state and federal funds over the 2012–13 biennium and beyond. Of that, Texas taxpayers will be responsible for $98 million, according to the
July 2012 TEXAS MEDICINE 21
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